Chemical Weapons: DOD Does Not Have a Strategy to Address Low-Level
Exposures (Letter Report, 09/23/1998, GAO/NSIAD-98-228).

Despite research indicating that even low-level exposure to chemical
weapons can impair short-term performance and cause long-term health
problems, the Defense Department (DOD) has yet to develop an integrated
strategy to defend U.S. troops against this battlefield threat.
Specifically, it has neither stated a policy nor developed a doctrine on
protecting soldiers from low-level chemical exposure. Less than two
percent of the research, development, test, and evaluation funds in
DOD's chemical and biological defense program during the past two years
have gone to study this issue. DOD's current strategy is to maximize the
effectiveness of troops in a lethal environment involving nuclear,
biological, and chemical agents. However, research by DOD and others
indicates that a single exposure to some chemical warfare agents can
have adverse psychological, behavioral, and performance consequences.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  NSIAD-98-228
     TITLE:  Chemical Weapons: DOD Does Not Have a Strategy to Address
	     Low-Level Exposures
      DATE:  09/23/1998
   SUBJECT:  Ground warfare
	     Medical research
	     Chemical warfare
	     Biological warfare
	     Hazardous substances
	     Disease detection or diagnosis
	     Defense capabilities
	     Military personnel
	     Military research and development
IDENTIFIER:  Persian Gulf War
	     Desert Storm

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GAO/NSIAD-98-228

Cover
================================================================ COVER

Report to Congressional Requesters

September 1998

CHEMICAL WEAPONS - DOD DOES NOT
HAVE A STRATEGY TO ADDRESS
LOW-LEVEL EXPOSURES

GAO/NSIAD-98-228

Low-Level Chemical Weapons

(713028)

Abbreviations
=============================================================== ABBREV

  CIA - Central Intelligence Agency
  DFP - diisopropyl fluorophosphate
  DOD - Department of Defense
  NBC - nuclear, biological, and chemical
  OSD - Office of the Secretary of Defense
  RDT&E - research, development, test, and evaluation

Letter
=============================================================== LETTER

B-280551

September 23, 1998

The Honorable Robert C.  Byrd
Ranking Minority Member
Committee on Appropriations
United States Senate

The Honorable John Glenn
Ranking Minority Member
Committee on Governmental Affairs
United States Senate

The Honorable Carl Levin
Ranking Minority Member
Committee on Armed Services
United States Senate

The possible exposure of U.S.  troops to low levels of chemical
warfare agents in Iraq in the weeks after the Gulf War ceasefire,
along with chemical warfare prophylaxis, vaccines, oil well fire
emissions, and other battlefield effluents, is suspected to be a
contributing factor in the unexplained illnesses that have plagued
some Gulf War veterans.  Members of Congress have raised concerns
regarding the adequacy of Department of Defense (DOD) policy,
doctrine, and technology to identify, prepare for, and defend troops
against the possible adverse effects of exposure to low-level
chemical warfare agents.  As you requested, we examined DOD's
approach for addressing U.S.  troop exposures to low levels of
chemical warfare agents.  Specifically, we (1) determined the extent
that DOD doctrine addresses exposures to low levels of chemical
warfare agents; (2) evaluated the extent that research addresses the
performance and health effects of exposures to low levels of chemical
warfare agents, either in isolation or combination with other agents
and contaminants that would be likely found on the battlefield; and
(3) identified the portion of resources in DOD's chemical and
biological defense research, development, test, and evaluation
(RDT&E) program explicitly directed at low-level chemical warfare
agent exposures.  Appendix I discusses the scope and methodology of
this review, and a glossary of scientific and medical terms appears
at the end of this report.  A subsequent report will assess chemical
and biological defense equipment technology.

   BACKGROUND
------------------------------------------------------------ Letter :1

Approximately 100,000 U.S.  troops may have been exposed to low
levels of chemical warfare agents in Operation Desert Storm.  The
destruction of Iraqi chemical warfare munitions by U.S.  demolition
units in a pit area at the Khamisiyah Ammunition Depot in March 1991
resulted in the release of sarin/cyclosarin nerve agents.\1 (See app.
II for a listing of common chemical warfare agents.) The Central
Intelligence Agency (CIA) and DOD estimated in September 1997 that
the demolition of Iraqi chemical-filled munitions released plumes of
nerve agent gas that extended over U.S.  troops located hundreds of
kilometers away from Khamisiyah.\2 Even though uncertainties
regarding wind, agent purity, released quantities, and unit locations
prohibit definitive calculations of the dose and length of exposures,
if any, to individual soldiers, the agencies estimated that 98,910
U.S.  troops were potentially exposed to at least the general
population limit dose.\3 In addition, the CIA estimated that
destruction of sarin/cyclosarin-filled rockets in a Khamisiyah Depot
bunker conducted several days prior to the pit area demolition may
have released additional nerve agents, resulting in further low-level
exposures.\4

The objective of DOD's nuclear, biological, and chemical (NBC)
defense program is to enable U.S.  forces to survive, fight, and win
in NBC warfare environments.  The National Defense Authorization Act
for Fiscal
Year 1994 directed the Secretary of Defense to assign responsibility
for overall coordination and integration of the chemical and
biological defense program to a single office within Office of the
Secretary of Defense (OSD).\5 The legislation also directed the
Secretary of Defense to designate the Army as DOD's executive agent
to coordinate chemical and biological RDT&E across the services.
(App.  III discusses the institutional structure and responsibilities
derived from this legislation.) As a result, individual service
research programs addressing NBC defense issues, including the
potential adverse effects of low-level chemical agent exposures, were
consolidated into a joint program.

The Army's Chemical School is responsible for the NBC doctrine, which
consists of joint doctrine,\6 service field manuals,\7 and training
circulars.
A Joint NBC Defense Concept provides guidance for protecting a force
against existing and emerging threats.  Threat information is used to
determine the vulnerability of existing systems.  The validation of a
vulnerability leads to a mission and needs statement and operational
readiness document and creates a requirement that can justify
additional research, revisions in doctrine, or new NBC defense
equipment acquisitions.

--------------------
\1 Chemical warfare agents are categorized based on their primary
effects.  The categories include nerve, vesicants or blister,
pulmonary, incapacitating, vomiting, cyanides, and tear.

\2 Modeling the Chemical Warfare Agent Release at the Khamisiyah Pit,
CIA/DOD, Sept.  4, 1997.

\3 CIA modeled the estimated area of chemical warfare agent release
at six levels of concentration--lethal, incapacitated/disabled,
vision impaired, first effects, 8-hour occupational limit, and
72-hour general population limit.  The general population limit dose
is defined as the dosage below that the general population, including
children and the elderly, could be expected to remain 72 hours with
no effects.

\4 Low-level chemical warfare agent fallout could have occurred as a
result of U.S.  bombing of three Iraqi chemical weapon facilities in
central Iraq--Muhammadiyat, Al Muthanna, and Ukhaydir.  CIA estimated
that low levels of sarin and mustard were dispersed as far as 300 and
130 kilometers, respectively, from Muhammadiyat and that sarin was
dispersed up to 160 kilometers from Al Muthanna.  Mustard agent
released from Ukhaydir would not have exceeded the general population
limit beyond 40 kilometers from the site.  CIA modeling estimates
indicate that chemical warfare agents from these releases did not
reach areas occupied by coalition troops.  However, these incidents
of inadvertent releases of chemical warfare agents due to aerial
bombing demonstrate low-level exposure threats to U.S.  troops that
can be encountered in future contingencies when the adversary
possesses chemical warfare research, production, or storage
facilities.  In addition, DOD identified 12 other instances of
suspected chemical warfare agent exposures during Operation Desert
Storm.

\5 Title XVII of Public Law 103-160, 50 U.S.C.  1522 (b).

\6 Joint Doctrine for NBC Defense, Joint Publication 3-11, was last
issued in July 1995.  It is currently being revised to address
deficiencies identified in a 1997 review by the Joint Warfighting
Center.  The revised doctrine is scheduled to be delivered to the
Joint Chiefs of Staff no later than September 1998.

\7 The Army maintains 20 field manuals that address a range of NBC
defense topics and operations, such as contamination avoidance, fixed
site protection, decontamination, potential agents and compounds, and
reconnaissance.

   RESULTS IN BRIEF
------------------------------------------------------------ Letter :2

DOD does not have an integrated strategy to address low-level
exposures to chemical warfare agents.  Specifically, it has not
stated a policy or developed a doctrine on the protection of troops
from low-level chemical exposures on the battlefield.  Past research
indicates that low-level exposures to some chemical warfare agents
may result in adverse short-term performance and long-term health
effects.  DOD has no chemical defense research program to determine
the effects of low-level chemical exposures.  Less than 2 percent of
the RDT&E funds in DOD's chemical and biological defense program have
been allocated to low-level issues in the last 2 fiscal years.

DOD's current NBC doctrine is focused on mission accomplishment by
maximizing the effectiveness of troops in a lethal NBC environment.
It does not address protection of the force from low-level chemical
warfare agent exposures on the battlefield.  According to officials,
DOD does not have doctrine that addresses low-level exposures because
there is no (1) validated low-level threat, (2) consensus on the
definition or meaning of low-level exposures, or (3) consensus on the
effects of low-level exposures.

Past research by DOD and others indicates that single and repeated
low-level exposures to some chemical warfare agents can result in
adverse psychological, physiological, behavioral, and performance
effects that may have military implications.  The research, however,
does not fully address the effects of low-level exposures to a wide
variety of agents, either in isolation or combination with other
agents and battlefield contaminants; chronic effects; reliability and
validity of animal-human extrapolation models; the operational
implications of the measured adverse impacts; and delayed performance
and health effects.

During the last 2 fiscal years, DOD has allocated nearly $10 million,
or approximately 1.5 percent of its chemical and biological defense
RDT&E budget of $646 million, to fund research and development
projects on low-level chemical warfare agent exposure issues.
However, these projects were not part of a structured DOD research
program focused on low-level effects.  Currently, DOD does not have a
chemical and biological defense research program designed to evaluate
the potential effects of low-level chemical warfare agent exposures,
but funding is under consideration for two multiyear research
programs addressing low-level effects.

   OSD POLICY AND DOD DOCTRINE ON
   LOW-LEVEL CHEMICAL WARFARE
   AGENT EXPOSURES
------------------------------------------------------------ Letter :3

OSD has not issued a policy, nor has DOD developed doctrine, to
address exposures of U.S.  troops to low levels of chemical warfare
agents on the battlefield.  DOD officials explained that low-level
exposures were not addressed because there was no validated threat
and no consensus on what constituted low-level exposures or whether
they produced adverse performance or health effects in humans.
Nevertheless, some entities within DOD are preparing chemical defense
strategies and developing technologies that are expected to address
low-level exposures.

      NO OSD POLICY OR DOD
      DOCTRINE ON LOW-LEVEL
      EXPOSURES
---------------------------------------------------------- Letter :3.1

OSD has not issued a policy on the force protection regarding
low-level chemical weapon agent exposures, and DOD has not developed
doctrine that addresses low-level exposures to chemical warfare
agents, either in isolation or combination with other contaminants
that would likely be found on the battlefield.  DOD officials have
characterized the primary intent of existing NBC doctrine for
battlefield management as enabling mission accomplishment by ensuring
force preservation rather than force protection.

The operational concept that underlies NBC doctrine and drives
chemical warfare defense research, development, and acquisition has
been to "fight through" the chemical and biological threat and
accomplish the mission, with the assumption that overwhelming
conventional capabilities will enable U.S.  forces to prevail on the
battlefield.  Thus, the focus on massive battlefield chemical weapon
use has framed the concepts of the role of chemical and biological
defense in warfare.  In a battlefield scenario, the NBC defense goal
is to ensure that chemical exposures to the troops result in less
than 1 percent lethalities and less than 15 percent casualties,
enabling the affected unit to remain operationally effective.

Nevertheless, DOD doctrine differentiates between possible high-level
chemical warfare threats in foreign battlefield scenarios and
low-level chemical exposures in domestic chemical weapon storage and
destruction facilities.  In a domestic chemical storage scenario,
facilities and procedures are required to ensure that unprotected
workers would receive no more than an 8-hour occupational exposure
limit and that the adjacent civilian population would receive no more
than a 72-hour general population limit, both of which are not
expected to result in any adverse health effects.

According to DOD, its doctrine does not address low-level exposures
on the battlefield because there is no (1) validated threat, (2)
definition of low-level exposures, (3) or consensus on the effects of
such exposures.  Moreover, if low-level exposures were to be
addressed, DOD officials said that the cost implications could be
significant.  For example, increased costs could result from the need
for more sensitive chemical detectors, more thorough decontamination
systems, or more individual and collective protection systems.
However, no studies have been done to evaluate the potential cost
implications of expanding policy and doctrine to address low-level
exposure concerns for force protection.  OSD officials said that any
future low-level requirements would need to compete for funds with an
existing list of unfunded chemical and biological defense needs.

In October 1997, the Presidential Advisory Committee on Gulf War
Veterans' Illnesses noted that existing DOD doctrine addresses only
exposure to debilitating or lethal doses of nerve or mustard chemical
warfare agents on the battlefield.  The Committee subsequently
recommended that DOD develop doctrine that addresses possible
low-level subclinical exposure to chemical warfare agents.\8
Specifically, the Committee recommended that DOD's doctrine establish
requirements for preventing, monitoring, recording, reporting, and
assessing possible low-level chemical warfare agent exposure
incidents.\9 In his February 1998 testimony before the House
Committee on Veterans' Affairs, the Special Assistant to the Deputy
Secretary of Defense for Gulf War Illnesses stated that DOD does not
believe there is a need for doctrine concerning low-level chemical
exposures but that DOD would consider taking action if research
indicates a need for such doctrine.

--------------------
\8 Generally, subclinical manifestations are so slight as to be
unnoticeable or not demonstrable.  Nonetheless, subclinical levels of
exposure to chemical warfare agents can result in changes in brain
activity as measured by an electroencephalogram (commonly known as an
EEG) and may result in long-term health effects.  Clinical levels of
exposure result in physiological symptoms ranging from dilation of
the pupils or runny nose up to apnea, convulsions, and loss of
consciousness.

\9 The Committee had concerns about (1) the lack of doctrine
standardizing the reporting and retention of possible chemical
warfare agent detections; (2) the incompatibility of doctrine for the
M93A1 NBC Reconnaissance System (also known as the Fox) to confirm
initial chemical detections with battlefield operations; (3) the
capabilities and use of chemical warfare agent detectors of the
battlefield to detect low-level, subclinical concentrations; and (4)
monitoring, documenting, and reporting early health effects of
possible chemical exposure incidents by location.

      NO VALIDATED LOW-LEVEL
      THREAT
---------------------------------------------------------- Letter :3.2

DOD officials said that there is no validated low-level threat and
that the probability of encountering low-level contaminated
conditions on the battlefield is minimal.  If low-level chemical
exposures were to occur, the officials stated that the exposures
would likely be inadvertent and momentary--resulting from residual
contamination after the use of high-dose chemical munitions.  DOD
experts on the storage and release of chemical warfare agents have
asserted that only in a laboratory could agent dosages exist at a low
concentration more than momentarily.

Nevertheless, DOD has studied how the intentional use of low doses of
chemical warfare agents could be used to achieve terrorist and
military objectives.  DOD raised concerns over the intentional use of
low-level chemical warfare agents in its 1997 study, Assessment of
the Impact of Chemical and Biological Weapons on Joint Operations in
2010, which analyzed the impact of state-sponsored terrorist attacks
using chemical warfare agents.  The study's threat scenario, which
was not validated by any intelligence agency, entailed chemical
warfare agents being spread thinly, avoiding lethal levels as much as
possible, for the purpose of stopping U.S.  military operations and
complicating detection and cleanup.  The study found that massive
battlefield use of chemical and biological weapons is no longer the
most likely threat and that U.S.  forces must be able to counter and
cope with limited, localized chemical and biological attacks,
including attacks delivered by asymmetrical means.\10 This study
exposed serious vulnerabilities to the U.S.  power projection
capabilities that could be exploited by the asymmetrical employment
of chemical and biological weapons both in the United States and in
foreign theaters of operation.  The study also found that the U.S.
intelligence capability to determine small-scale development and
intent to use chemical or biological weapons, particularly for
limited use, is inadequate.  Shortfalls include insufficient ability
to collect and assess indications and warnings of planned low-level
chemical and biological attacks.  The report concluded that OSD
should significantly increase its level of attention to
vulnerabilities posed by an enemy using asymmetrical and limited
applications of chemical and biological weapons.

--------------------
\10 In the study, asymmetrical delivery means included a two-seat
helicopter, a crop duster, and a used delivery truck with a makeshift
storage tank and discharge valve.

      LACK OF CONSENSUS ON THE
      DEFINITION OF LOW-LEVEL
      EXPOSURES
---------------------------------------------------------- Letter :3.3

The absence of an OSD policy or DOD doctrine on low-level exposures
is partly attributable to the lack of a consensus within DOD on the
meaning of low level.  DOD officials responsible for medical chemical
defense, nonmedical chemical defense, NBC doctrine, and NBC
intelligence provided varying definitions of low-level exposure,
including the Oxford Dictionary definition, no observable effects,
sublethal, and 0.2 LD50.\11 Despite the differing responses, each one
can be depicted as a location along the lower end of a chemical
warfare agent exposure and effects continuum.  (App.  IV describes
physiological effects from increasing levels of chemical warfare
agent exposures.) Figure 1 shows that one end of the continuum is
extremely high exposures that result in death, and the other end is
no or minimal exposures that result in no performance or health
effects.  Between these extremes is a range of exposures and
resulting effects.

   Figure 1:  Chemical Warfare
   Agent Exposure and Effects
   Continuum

   (See figure in printed
   edition.)

Note:  The various stages of effects are not shown to scale.  The
specific exposure that would invoke the various types of effects will
vary with the type of chemical warfare agent and the conditions of
exposure, such as agent concentration, agent form, route and time of
exposure, and characteristics of exposed subject.

--------------------
\11 LD50 is the median lethal dose, meaning that one-half of a
population receiving this dose will die.

      LACK OF CONSENSUS ON THE
      EFFECTS OF LOW-LEVEL
      EXPOSURES
---------------------------------------------------------- Letter :3.4

In addition to a lack of consensus on the definition or meaning of
low-level exposures, there is a lack of consensus within DOD and the
research community on the extent and significance of low-level
exposure effects.  These differences result from several factors.
First, the chemical warfare agent dose-response curves can be quite
steep,\12 leading some DOD officials and researchers to question the
concern over a very narrow range of sublethal dose levels.  Second,
the extrapolation of findings from studies on the effects of chemical
warfare agent exposures in animals to humans can be imprecise and
unpredictable.  Third, the impacts of different methods of chemical
warfare agent exposure, such as topical, injection, and inhalation,
may result in varied manifestations and timings of effects, even with
comparable concentrations and subject conditions.  For example, many
of the effects attributable to chemical warfare agent exposure are
subjective and either do not occur or cannot be measured in many
animal species.  Fourth, the preponderance of information on the
combined effects of low-level exposures is lacking.  Nearly all
research on low-level effects addresses single agents in isolation;
defining low levels of an agent when present in combination with
other battlefield contaminants has not been addressed.  In addition,
most research has involved single, acute exposures with observations
made over several hours or days.  Few studies have examined the
possible long-term effects of continuous or repeated low-level
exposures.

Last, research is not yet conclusive as to what level of exposure is
militarily or operationally significant.  The impact of a specific
symptom resulting from chemical warfare agent exposure may vary by
the military task to be performed.  For example, miosis (constriction
of the eye's pupil) may have a greater adverse impact on a pilot or a
medical practitioner than a logistician.  Nonetheless, the dose and
effects data are only some of the many factors considered in risk
analyses conducted by military commanders.  DOD officials told us
that trade-offs among competing factors are more often than not based
on professional judgment of persons with extensive knowledge based on
military and technical education, training, and experience rather
than an algorithm with numerical input and output.

--------------------
\12 The dose-response curve reflects the change in effects for each
additional unit of exposure.  For highly toxic organophosphate nerve
agents, the difference between the dose that creates the first
adverse response and the lethal dose can be small.  Dose-response
curves have been developed for several animal species through
laboratory testing; similar testing to develop a dose-response curve
in humans has not been done.

      DISPARATE INDEPENDENT
      LOW-LEVEL INITIATIVES ARE
      ORIGINATING WITHIN DOD
---------------------------------------------------------- Letter :3.5

Despite the lack of an OSD policy on low-level exposures, some
elements within DOD have begun to address issues involving such
exposures.  In describing DOD's NBC defense strategy for the future,
the Chairman of the Joint Service Materiel Group noted that the
presence of low levels of chemical warfare agents will be one of the
factors to consider before sending U.S.  troops to a contingency.
Specifically, the future strategy will no longer be primarily shaped
by the occurrence of mild physiological effects, such as miosis, but
rather the possible long-term health effects to U.S.  forces.
Lessons learned from the Gulf War are reflected in DOD's NBC defense
strategy, which focuses on the asymmetrical threat.  Gulf War
Syndrome and low-level threats are identified as two of the concerns
to be addressed in the future NBC defense strategy.  The Group
Chairman added that traditionally the de facto low-level definition
has been determined by DOD's technical capability to detect the
presence of an agent.  However, the Chairman stated that the
low-level concept in future chemical defense strategies will need to
be defined by the medical community and consider the long-term health
effects of battlefield environments.

The Joint Service Integration Group--an arm of the Joint NBC Defense
Board that is responsible for requirements, priorities, training, and
doctrine--is working with the services to create a joint NBC defense
concept to guide the development of a coherent NBC defense program.
One of the central tenets of the proposed concept is to provide
effective force protection against exposure threats at the lower end
of the continuum, such as those from terrorism and industrial
hazards.  Also, the proposed concept envisions a single process for
force protection to provide a seamless transition from peacetime to
wartime.  Even though the levels and types of threat can differ, a
single overall process can meet all joint force protection needs.
Thus, the NBC joint concept will address threats against DOD
installations and forces for both peacetime and military conflicts.
In addition, the joint concept will provide a conceptual framework
for defense modernization through 2010, but the specific programs and
system requirements necessary for the implementation of the concept
will not be articulated.

The services are concurrently identifying NBC defense joint future
operational capabilities to implement the joint concept.  Several of
these capabilities relate to low-level exposure, such as (1)
improving detection limits and capabilities for identifying standard
chemical warfare agents by 50 percent, (2) lowering detection
sensitivity limits and detection response times for identifying
standard chemical warfare agents by 50 percent, and (3) lowering
detection response time for standard biological agents by at least 50
percent.\13

Even in the absence of adopted joint force operational capabilities,
DOD is incorporating low-level capabilities in the design of new
chemical defense equipment.  For example, the Joint Chemical Agent
Detector, currently under development, is expected to provide an
initial indication that a chemical warfare attack has occurred and
detect low-level concentrations of selected chemical warfare agents.
The detector will replace currently fielded systems that have a
limited ability to provide warning of low-dose hazards from chemical
warfare agents.\14 The operational requirements for the detector
specify that it will be able to detect low-level concentrations of
five nerve agents and two blister agents.  However, the low-level
requirement necessitates trade-offs between the breadth of agents
that the detector can identify and its ability to monitor low-level
concentrations for a select few agents.  Thus, the next-generation
chemical warfare agent detector is expected to have a capability to
detect lower chemical warfare agent concentrations in more locations.
In the absence of policy--or additional research on low-level
effects--it cannot be known whether the current, less capable
detectors would have the appropriate capabilities to meet the
requirements of a low-level exposure doctrine.

--------------------
\13 Although the joint concept and the joint future operational
capabilities reflect a need to improve force protection capabilities,
these initiatives do not define what level of protection is
appropriate.  Therefore, we cannot determine if the improved
capabilities are either necessary or adequate.

\14 According to the operational requirements document for the Joint
Chemical Agent Detector, existing systems, such as the M-8 paper, M-9
tape, and M8A1 and M256A1 kits are time-consuming, labor-intensive,
and subject to false readings.  The Chemical Agent Monitor and M90
Automatic Agent Detectors are not sensitive enough to provide
warnings of low-dose hazards, leading to miosis.  Other detection
systems are limited by shortcomings in mobility; usefulness on
aircraft; and sensitivity to nonchemical warfare agent exposures,
such as organic vapors or electromagnetic interference.

   RESEARCH ON PERFORMANCE AND
   HEALTH EFFECTS OF LOW-LEVEL
   EXPOSURES
------------------------------------------------------------ Letter :4

Research on animals and humans conducted by DOD and others has
identified some adverse psychological, physiological, behavioral, and
performance effects of low-level exposure to some chemical warfare
agents.  Nonetheless, researchers do not agree on the risk posed by
low-level exposures and the potential military implications of their
presence on the battlefield, whether in isolation or in combination
with other battlefield contaminants.  DOD has no research program to
address the remaining uncertainties regarding the performance and
health effects of low-level exposures to chemical warfare agents;
however, two new research initiatives are currently under
consideration.

      PREVIOUS RESEARCH
---------------------------------------------------------- Letter :4.1

The majority of the chemical warfare agent research has been on
organophosphate\15

nerve agents and related pesticides.  At low doses, nerve agents
produce a wide range of effects on the central nervous system,
beginning with anxiety and emotional instability.  Psychological
effects in humans from nerve agent VX on skin have been noted earlier
than physical effects (e.g., nausea and vomiting) or appeared in the
absence of physical effects.  The psychological effects were
characterized by difficulty in sustaining attention and slowing of
intellectual and motor processes.  Doses considerably below the LD50
can degrade performance and alter behavior.  These performance and
behavioral effects have clear military implications because affected
service personnel exposed to chemical warfare agents might not only
lose the motivation to fight but also lose the ability to defend
themselves and carry out the complex tasks frequently required in the
modern armed forces.  Moreover, the detrimental effects of exposure
to single doses of nerve agents may be prolonged.\16

Concern about low-level chemical warfare agent effects predate
Operation Desert Storm.  In the 1980s, the Air Force conducted
research on the bioeffects of single and repeated exposures to low
levels of the nerve agent soman due to concerns about the effects of
low-level chemical agent exposures on vulnerable personnel--such as
bomb loaders, pilots, and medical personnel--who may be required to
work in low-level contaminated environments.\17 The Air Force found
that the nerve agent degraded performance on specific behavior tasks
in the absence of obvious physical deficits in primates.  Thus, even
for extremely toxic compounds, such as organophosphate nerve agents,
which have a steep dose-response curve, task performance deficits
could be detected at low levels of exposure that did not cause any
overt signs of physical toxicity.  This research was unique because
low-level exposures were thought at that time to be unlikely or
unrealistic on the battlefield.

Table 1 shows examples of research conducted or funded by DOD on the
behavioral and performance effects of organophosphate nerve agents.
The research examples reveal that sublethal exposures of an agent can
have a variety of effects (depending on the species, exposure
parameters, time, and combination of exposures) and produce
measurable, adverse effects on physiology and behavior (both motor
and cognitive\18 performance).

                                                                       Table 1

                                                        Examples of Research on the Effects of
                                                       Low-Levels of Organophosphorus Chemical
                                                               Nerve Agents in Animals

                                                                                                Performance or
Source                                      Agent           Species       Exposure              response test           Performance effects
------------------------------------------  --------------  ------------  --------------------  ----------------------  -----------------------------
Air Force Armstrong Laboratory,             Soman           Rhesus        2.5 g/kg,    Primate equilibrium     Reliable decrements in
Brooks Air Force Base, Tex.\a                               monkeys       acute (e.g., single)  platform,\b             sensory-motor equilibrium
                                                                          dose; given by        observations in 5-      performance noted in the
                                                                          injection (dose is    minute intervals up to  absence of any obvious
                                                                          less than one-third   90 minutes after        physical signs of toxicity
                                                                          of LD50)              injection

Air Force Armstrong Laboratory,             Soman           Rhesus        0.97 g/kg/   Primate equilibrium     50 percent of primates
Brooks Air Force Base, Tex.                                 monkeys       day, repeated;        platform, observations  experience performance
                                                                          single doses on 5     daily                   decrements
                                                                          consecutive days,                             (e.g., ED50)
                                                                          given by injection

Battelle Memorial Institute, Columbus,      Soman           Rats          90, 103, 116          Behavioral parameters:  Sublethal doses of soman can
Ohio; and                                                                 g/kg, given  grip strength; startle  cause marked and often long-
Army Chemical Research and Development                                    by injection (LD50    response, conditioned   lasting changes in behavior,
Center,                                                                   is 185 g/    avoidance measured on   such as impaired grip
Aberdeen Proving Ground, Md.\c                                            kg)                   days 0, 1, 3, 7, 14,    strength, increased latency,
                                                                                                and 21                  increased spontaneous motor
                                                                                                                        activity, and
                                                                                                                        hyperexcitability

Neurophysiology Laboratory, Children's      Sarin           Rhesus        1 g/kg,      EEG; 24 hours and 1     Significant increase in beta
Hospital Center,                                            monkeys       weekly for 10         year                    activity persisted for 1 year
Harvard Medical School, Boston, Mass.;                                    weeks,                postinjection in three
and                                                                       given by injection    states of
the Biomedical Laboratory, Edgewood                                                             consciousness
Arsenal,
Aberdeen Proving Ground, Md.\d

Medical College of Georgia Research         DFP             Rats          Daily doses of 0.25   Water maze and delayed  Withdrawal from repeated
Institute,                                  (Diisopropyl                  mg/kg for             stimulus                exposures impaired
Augusta, Ga.\e                              fluorophosphat                14 days, given by     discrimination task, 7  acquisition of novel
                                            e)                            injection             to 16 days after        cognitive tasks but not the
                                                                                                completion of agent     performance of memory tasks
                                                                                                regimen                 dependent on reference
                                                                                                                        concepts

Air Force School of Aerospace Medicine,     Ionizing        Rats          7 Gy and 0.1 mg/kg,   Rotarod (balance) and   60 percent performance
Brooks Air Force Base, Tex.\f               radiation and                 acute dose, given by  four general motor      decrement at 45 minutes in
                                            anticholineste                injection             activity measures,      combination versus
                                            rase                                                observations            30 and 40 percent decrements
                                            physostigmine                                       preirradiation and      from radiation-or
                                                                                                45 minutes, 4 days,     physostigmine-only exposures,
                                                                                                and                     respectively
                                                                                                8 days postirradiation
-----------------------------------------------------------------------------------------------------------------------------------------------------
Note:  The examples were judgmentally selected to illustrate the
types of methodologies that have been applied to the variety of
effects that have been observed.  This information table is not meant
to be representative of the research literature.  See the glossary of
terms at the end of the report for definitions of units of
measurement.

\a Hartgraves, S.L., and M.R.  Murphy.  "Behavioral Effects of
Low-Dose Nerve Agents." In:  ed.  S.M.  Somani.  Chemical Warfare
Agents.  San Diego:  Academic Press, 1992.

\b The primate equilibrium platform test is a sensory-motor
equilibrium task requiring both fine motor control (for joystick
manipulation) and the integrity of the complex sensorimotor system
for maintaining equilibrium and orientation in space.

\c Haggerty, G.C., et al.  "Duration and Intensity of Behavioral
Change After Sublethal Exposure to Soman in Rats." Neurobehavioral
Toxicology and Teratology, vol.  8 (1986), pp.  695-702.

\d Burchfiel, J.L., et al.  "Persistent Effects of Sarin and Dieldrin
Upon the Primate Electroencephalogram." Toxicology and Applied
Pharmacology, vol.  35 (1976), pp.  365-379.

\e Buccafusco, J.J., "Chronic Organophosphorus Exposure and
Cognition." Annual Report, U.S.  Army Medical Research and Materiel
Command, 1997.

\f Wheeler, T.G., and R.E.  Cordts.  Combined Effects of Ionizing
Radiation and Anticholinesterase Exposure on Rodent Motor
Performance.  U.S.  Air Force School of Aerospace Medicine, Report
number USAFSAM-TR-83-30, July 1983.

In our prior report on Gulf War illnesses,\19 we summarized research
on the long-term health effects of chemical warfare agents, which
were suspected of contributing to the health problems of Gulf War
veterans.  The report cited research suggesting that low-level
exposure to some chemical warfare agents or chemically related
compounds, such as certain pesticides, is associated with delayed or
long-term health effects.  Regarding delayed health effects of
organophosphates, we noted evidence from animal experiments, studies
of accidental human exposures, and epidemiological studies of humans
that low-level exposures to certain organophosphorus compounds,
including sarin nerve agents to which some U.S troops may have been
exposed, can cause delayed, chronic neurotoxic effects.\20

We noted that, as early as the 1950s, studies demonstrated that
repeated oral and subcutaneous exposures to neurotoxic
organophosphates produced delayed neurotoxic effects in rats and
mice.  In addition, German personnel who were exposed to nerve agents
during World War II displayed signs and symptoms of neurological
problems even 5 to 10 years after their last exposure.  Long-term
abnormal neurological and psychiatric symptoms, as well as disturbed
brain wave patterns, have also been seen in workers exposed to sarin
in manufacturing plants.\21 The same abnormal brain wave disturbances
were produced experimentally in nonhuman primates by exposing them to
low doses of sarin.\22 Delayed, chronic neurotoxic effects have also
been seen in animal experiments after the administration of
organophosphate.  In other experiments, animals given a low dosage of
the nerve agent sarin for 10 days showed no signs of immediate
illness but developed delayed chronic neurotoxicity after
2 weeks.\23

Nonetheless, some DOD representatives in the research community have
expressed considerable doubt that low-level exposures to chemical
warfare agents or organophosphates pose performance and long-term
health risks--particularly in regard to the likelihood that low-level
exposures are linked to Gulf War illnesses.  These doubts stem from
the lack of a realistic scenario, the lack of adverse long-term
health effects observed in studies of controlled and accidental human
exposure or animal studies, and results that are viewed as
incompatible with the principles of biology and pharmacology.\24

Researchers we interviewed did agree that the work that has been done
to date is lacking in several aspects, including (1) the effects of
exposure to low levels of chemical warfare agents in combination with
other agents or contaminants likely found on future battlefields; (2)
extrapolation of animal models to humans; (3) the breadth of agents
tested, types of exposure routes, and length of exposure; and (4) the
military or operational implications of identified or projected
low-level exposure effects.\25

--------------------
\15 Organophosphates are a family of chemical compounds that inhibit
cholinesterase and can be formulated as pesticides and nerve agents.

\16 The North Atlantic Treaty Organization's Handbook on Medical
Aspects of NBC Defensive Operations states that (1) daily exposure to
concentrations of a nerve agent insufficient to produce symptoms
after a single exposure may result in the onset of symptoms after
several days and that continued daily exposure may result in
increasingly severe effects and (2) after symptoms subside, increased
susceptibility may persist for up to 3 months.  The degree of
exposure required to produce recurrence of symptoms and the severity
of these symptoms depend on the dose received and the time since the
last exposure.  Increased susceptibility is not limited to the
particular nerve agent initially absorbed.

\17 The Navy also was interested in low-level effects and directly
supported the Air Force's research projects in the late 1980s.

\18 Cognitive thought processes are based on perception, memory, and
judgment.

\19 Gulf War Illnesses:  Improved Monitoring of Clinical Progress and
Reexamination of Research Emphasis Are Needed (GAO/NSIAD-97-163, June
23, 1997).

\20 This syndrome is characterized by clinical signs and symptoms
manifested 4 to 21 days after exposure to organophosphate compounds.
The symptoms of delayed neurotoxicity can take at least two forms.  A
single large dose may cause nerve damage with paralysis and later
spastic movement or repetitive low doses may damage the brain,
causing impaired concentration and memory, depression, fatigue, and
irritability.  These delayed symptoms may be permanent.

\21 Duffy, F.H.  et al.  "Long-Term Effects of an Organophosphate
Upon the Human Electroencephalogram." Toxicology and Applied
Pharmacology, vol.  47 (1979), pp.  161-176.  Sidell, F.R., "Soman
and Sarin:  Clinical Manifestations and Treatment of Accidental
Poisoning by Organophosphates." Clinical Toxicology, vol.  7 (1979),
pp.  1-17.

\22 Burchfiel, J.L., et al.  "Persistent Effect of Sarin and Dieldrin
Upon the Primate Electroencephalogram." Toxicology and Applied
Pharmacology, vol.  35 (1976), pp.  365-379.

\23 Husain, K., et al.  "Assessing Delayed Neurotoxicity in Rodents
after Nerve Gas Exposure." Defense Science Journal, vol.  44 (1994),
pp.  161-164.  Husain, K., et al.  "Delayed Neurotoxic Effect of
Sarin in Mice After Repeated Inhalation Exposure." Journal of Applied
Toxicology, vol.  13 (1993), pp.  143-145.  Husain, K., et al.  "A
Comparative Study of Delayed Neurotoxicity in Hens Following Repeated
Administration of Organophosphorus in Compounds." Indian Journal of
Physiology and Pharmacology, vol.  39 (1995), pp.  47-50.

\24 The human body has a natural ability to scavenge or neutralize
organophosphates.  For example, natural scavengers can neutralize
approximately 0.2 LD50of soman while the agent is in the blood and
before it can affect the central nervous system.  Therefore, for each
nerve agent there may be a threshold of exposure below which no
effects will result.

\25 Much of the historic toxicological research on exposure effects
was conducted for an offensive chemical weapons program; therefore,
the results are likely not appropriate for a defensive chemical
weapons program.

      PROPOSED RESEARCH
      INITIATIVES
---------------------------------------------------------- Letter :4.2

Consistent with the absence of an OSD policy on low-level exposures,
there is no research objective under DOD's Joint Service Chemical and
Biological Defense Program to evaluate the potential effects of
low-level exposures.  However, even in the absence of a requirement,
there is a consensus within the research and doctrinal communities
that additional research on low-level effects is needed.  Researchers
told us that, although they do know that low-level exposures to
chemical warfare agents can have performance and health effects, more
was unknown than known about the effects of low-level exposures of
agents--either in isolation or in combination--and that more research
would be desirable.  According to one DOD scientist, "Research can
improve our understanding of the relationships among the many
factors, such as effects, time of onset of effects, duration of
effects, concentration, duration of exposure, dosage, and dose.
Improved estimates of effects in humans resulting from exposure to
chemical warfare agents are a requirement that has existed since
World War I."

Consistent with that assessment, the Army's Medical Research and
Materiel Command is proposing a science and technology objective\26
to establish a research program on the chronic effects of chemical
warfare agent exposure.  Because previous research efforts have
emphasized the acute effects of high (battlefield-level) exposures,
there is little information on the repeated or chronic effects of
low-dose exposures.  The Command's research effort is in response to
this lack of information and joint service requirements for knowledge
of the effects on personnel in sustained operations in areas that may
be chemically contaminated, thus creating the possibility of a
continuous low-level exposure.\27

Additionally, the Joint Service Integration Group has tasked a panel
of experts to determine an accepted definition for low-level chemical
warfare agent exposure.  The panel has proposed a series of research
efforts to the Joint NBC Defense Board to analyze the relationships
among dose, concentration, time, and effects for the purpose of
determining safe exposure levels for sustained combat operations.\28

DOD has funded two National Academy of Sciences studies to support
the development of a long-term strategy for protecting U.S.  military
personnel deployed to unfamiliar environments.  These studies will
provide guidance for managing health and exposure issues, including
infectious agents; vaccines; drug interactions; stress; and
environmental and battlefield-related hazards, such as chemical and
biological agents.  One study is assessing approaches and
technologies that have been or may be used by DOD in developing and
evaluating equipment and clothing for physical protection and
decontamination.  The assessment is to address the efficacy of
current policies, doctrine, and training as they relate to potential
exposures to chemical warfare agents during deployments.  The second
study is assessing technology and methods for detection and tracking
of exposures to a subset of harmful agents.  This study will assess
tools and methods to detect, monitor, and document exposures to
deployed personnel.  These studies do not address issues of risk
management; those will be the focus of a third study.

--------------------
\26 An approved science and technology objective validates an area as
worthy for research and helps provide a "fence" to protect funding to
the area being investigated or researched.

\27 We have not analyzed this or other draft research plans to
determine if the proposals, if implemented, would likely achieve
their objectives.

\28 Because the research programs sponsored by the Army Medical
Research and Materiel Command and the Joint Service Integration Group
have not been approved or implemented, we cannot assess their
objectives, scopes, or methodologies.

   LOW-LEVEL CHEMICAL RESEARCH
   FUNDING
------------------------------------------------------------ Letter :5

Although DOD and congressional interest concerning the effects of
low-level chemical exposure increased after events in the 1991 Gulf
War, relatively limited funding has actually been expended or
programmed in DOD's RDT&E programs in recent years to address issues
associated with low-level chemical exposure on U.S.  military
personnel.  However, DOD has developed proposals to fund two
low-level research efforts, which are under consideration for
implementation.

      CHEMICAL AND BIOLOGICAL
      DEFENSE PROGRAM RESEARCH
      FUNDING
---------------------------------------------------------- Letter :5.1

For fiscal years 1996 through 2003, DOD has been appropriated in
excess of $2.5 billion for chemical and biological defense RDT&E
programs.  (See
app.  V for general DOD chemical and biological program funding
allocations and trends for fiscal years 1990 through 2003).  Fiscal
year 1996 was the first time that RDT&E funding for all of DOD's
chemical and biological defense programs was consolidated into six
defensewide program element funding lines.  These program elements
are (1) basic research, (2) applied research, (3) advanced technology
development, (4) demonstration and validation, (5) engineering and
manufacturing development, and (6) management support.  Table 2 shows
total actual and projected research funding by RDT&E program element
for fiscal years 1996 through 2003.

                                Table 2

                 Chemical and Biological RDT&E Funding,
                         Fiscal Years 1996-2003

                         (Dollars in millions)

                                                        Amount
                                                        progra  Percen
Program element                                           mmed       t
------------------------------------------------------  ------  ------
Basic research                                          $215.4     8.6
Applied research                                         518.1    20.6
Advanced technology development                          319.7    12.7
Demonstration and validation                             356.4    14.2
Engineering and manufacturing development                944.2    37.5
Management support                                       161.7     6.4
======================================================================
Total                                                   $2,515   100.0
                                                            .5
----------------------------------------------------------------------

      RECENT LOW-LEVEL RESEARCH
      FUNDING
---------------------------------------------------------- Letter :5.2

Three low-level research efforts--totaling about $10 million--were
included in DOD's fiscal year 1997 and 1998 chemical and biological
defense RDT&E programs.  These research efforts represented about 1.5
percent of the approximately $646 million in combined obligational
authority authorized for chemical and biological defense RDT&E for
these 2 fiscal years.

Funding for the largest of the three--an $8-million effort in the
fiscal
year 1998 program that dealt with chemical sensor enhancements--was
provided by the Conference Committee on DOD Appropriations.\29
Another fiscal year 1998 effort--costing almost $1.4
million--involved the development of sensitive biomarkers of low-dose
exposure to chemical agents.  The remaining effort, included in the
fiscal year 1997 program, developed in vitro and in vivo model
systems to evaluate the possible effects of low-dose or chronic
exposures to chemical warfare agents.  This project cost
approximately $676,000.  DOD officials told us that these projects
were not part of a structured program to determine the performance
and health effects of low-level exposures.  However, two elements
within DOD have proposed multiyear research programs on low-level
issues.

--------------------
\29 The fiscal year 1998 Appropriations Conference Report, House
Report 105-265, added funds to the Chemical and Biological Defense
RDT&E program.  Specifically, an additional $10 million was added to
the applied research program element for chemical agent sensor
technology.  Subsequently, the Assistant to the Secretary of Defense
for NBC Defense Programs earmarked $8 million of the $10 million for
low-level chemical detection and monitoring technology.

      PROPOSED LOW-LEVEL RESEARCH
      FUNDING
---------------------------------------------------------- Letter :5.3

DOD has requested funding for the U.S.  Army Medical Research and
Materiel Command's science and technology objective on the chronic
effects of chemical warfare agent exposure.  If approved, this
research program is projected to receive an average of about $2.8
million annually in research funds for fiscal years 1999 through
2003.  The purpose of this undertaking would be to investigate the
effects of low-dose and chronic exposure to chemical agents to (1)
gain a better understanding of the medical effects of such exposure,
(2) provide tools for a medical assessment of personnel, and (3)
develop protocols for subsequent protection and treatment.  Figure 2
reflects DOD's programmed RDT&E funding for fiscal years 1999 through
2003 and shows the proposed science and technology objective in
relation to other research program efforts.

   Figure 2:  Programmed RDT&E
   Funding, Fiscal Years 1999-2003

   (See figure in printed
   edition.)

Another research program involving low-level chemical exposures will
be proposed in the near future to the NBC Defense Board for approval.
A panel of experts, tasked by DOD to study the issue of defining
low-level and chronic chemical exposure, has proposed a series of
research efforts to be undertaken over the next several years to
address the definitional dilemma surrounding this issue.  Funding
levels for this effort have not been established.

   CONCLUSIONS AND RECOMMENDATION
------------------------------------------------------------ Letter :6

DOD's current NBC policy and doctrine do not address exposures of
U.S.  troops to low levels of chemical warfare agents on the
battlefield.  NBC defense doctrine is focused on ensuring mission
accomplishment through the prevention of acute lethal and
incapacitating effects of chemical weapons and is not designed to
maximize force protection from exposure to clinical and subclinical
doses.  Moreover, DOD has no chemical defense research plan to
evaluate the potential performance effects of low-level exposures or
the implications they may have for force protection.  Even though
research funded by DOD and others has demonstrated adverse effects in
animal studies, the literature does not adequately address the
breadth of potential agents; the combinations of agents either in
isolation or in combination with battlefield contaminants; the
chronic effects; animal-human extrapolation models; or the
operational implications of the measured adverse impacts.

We recommend that the Secretary of Defense develop an integrated
strategy for comprehensively addressing force protection issues
resulting from low-level chemical warfare agent exposures.  The
strategy should address, at a minimum,

  -- the desirability of an OSD policy on the protection of troops
     from low-level chemical warfare agent exposures;

  -- the appropriateness of addressing low-level chemical warfare
     agent exposures in doctrine;

  -- the need for enhanced low-level chemical warfare agent
     detection, identification, and protection capabilities;

  -- the research needed to fully understand the risks posed by
     exposures to low levels of chemical warfare agents, in isolation
     and in combination with other contaminants that would be likely
     found on the battlefield; and

  -- the respective risks, costs, and benefits of addressing
     low-level chemical warfare agent exposures within DOD's chemical
     and biological defense program.

   AGENCY COMMENTS AND OUR
   EVALUATION
------------------------------------------------------------ Letter :7

In oral comments on a draft of this report, DOD concurred with our
recommendation that the Secretary of Defense develop a "low-level"
strategy but disagreed with the implied priority order.  DOD stated
that it is also concerned with force protection and the possible
impact that low-level chemical agent exposures might have on a
service member's health and emphasized that a valid data-based risk
assessment must serve as the foundation for any change in policy or
doctrine.  In addition, DOD provided us with updated plans and
proposals to develop an overall requirements and program strategy for
low-level chemical agent monitoring.

DOD agreed that the absence of an OSD policy or a DOD doctrine on
low-level exposures is partially attributable to the absence of a
consensus within DOD on the meaning of low level.  However, DOD
expressed concern that we did not assert a working definition of low
level as it might apply to a force projection or battlefield
scenario.  DOD disagreed with our selection of examples of low-level
research illustrated in table 1, stating that the studies were more
appropriately categorized as "low dose" rather than low level.
Finally, DOD believed that we misinterpreted the report, Assessment
of the Impact of Chemical and Biological Weapons on Joint Operation
in 2010, by failing to understand that the asymmetrical application
of chemical agents does not equate to "low level" for the purpose of
producing casualties, but rather for the purpose of disrupting
operations by the mere detectable presence of these agents at levels
that may have no medical effects.

In our recommendation, we listed a number of elements that should be
addressed in developing such a strategy, but we purposely did not
articulate a priority order beginning with research.  Rather, we
advocate that DOD develop a strategy to analyze policy, doctrine, and
requirements based on existing information and to reassess policy,
doctrine, and requirements as the results of a low-level research
program are reported.

We did not define low level in our report because the definition
requires an interpretation of both exposure effects data and military
risk and performance data--analyses best performed by DOD.
Furthermore, because a consensus of the meaning or definition of low
level is lacking, we find no basis for DOD's characterization of the
research examples in table 1 of the report as "low dose," rather than
"low level."

Regarding the 2010 Study, we disagree with DOD's statement that there
may not be medical effects for low-level chemical agents.  Rather our
work shows that low-level exposure can have medical effects that
cannot only result in casualties, but also disrupt operations.

The plan of action and low-level toxicological and technical base
efforts provided by DOD did not fully address the strategy that the
report discusses.  The strategy will require a plan of action
incorporating medical and tactical analyses, as well as the
nonmedical research and development projects described by DOD.

---------------------------------------------------------- Letter :7.1

As agreed with your offices, unless you publicly announce its
contents earlier, we plan no further distribution of this report
until 30 days after its issue date.  At that time, we will send
copies to other congressional committees and the Secretary of
Defense.  We will also make copies available to others on request.

If you have any questions concerning this report, please call me at
(202) 512-3092.  Major contributors to this report were Sushil
Sharma, Jeffrey Harris, Foy Wicker, and Betty Ward-Zukerman.

Kwai-Cheung Chan
Director, Special Studies and Evaluation

SCOPE AND METHODOLOGY
=========================================================== Appendix I

The scope of our study was limited to chemical defense and low-level
exposures that may cause adverse effects on performance.  To
determine the extent to which low-level exposures are addressed in
doctrine, we reviewed Department of Defense (DOD) documents and
interviewed agency officials.  We asked questions designed to elicit
the treatment of low-level issues within the nuclear, biological, and
chemical (NBC) doctrinal architecture (i.e., Joint Publication 3-11;
field manuals; training circulars; and tactics, techniques, and
procedures).  After determining that low-level issues were not
addressed in the war-fighting doctrine, we asked representatives of
the doctrinal, intelligence, and research communities why low-level
issues were not addressed and under what circumstances they would be
addressed.

To identify research on the performance effects of low-level exposure
of chemical warfare agents, we reviewed relevant government and
academic research (published and unpublished) and interviewed
researchers within and outside of DOD.  To identify relevant
literature, we interviewed DOD officials currently responsible for
prioritizing chemical and biological defense research needs.  We also
interviewed DOD researchers at the Army's primary center of medical
chemical defense research and development (the Army Medical Research
Institute for Chemical Defense) and nonmedical chemical research and
development (the Edgewood Research, Development, and Engineering
Center at the Aberdeen Proving Ground).  We interviewed staff at the
laboratory used by the Air Force to conduct low-level exposure
effects on animals before the Army was designated as executive agent
for chemical defense and the Air Force's effort ceased.  We sought
historic programmatic information from the Naval Medical Research and
Development Command, which funded portions of the Air Force's
low-level animal studies.  We monitored ongoing DOD-funded Gulf War
illnesses research that addresses potential long-term health effects
from low-dose or chronic chemical exposures.  Last, we discussed
current research with leading academics in the field.

We reviewed the compilation of relevant low-level research literature
to characterize coverage (variety and combinations of agents or
contaminants), methodologies employed, and effects observed.  These
observations were discussed and validated in our interviews with
researchers in chemical defense, both within and outside of DOD.  In
addition, we employed a research consultant from academia to review
the literature to substantiate both the comprehensiveness of our
compilation and the validity of our conclusions.

To determine what portion of the chemical defense budget specifically
addresses low-level exposures, we reviewed DOD documents and
interviewed DOD program officials.  We examined DOD planning and
budget documents, including the NBC defense annual reports to
Congress and joint service chemical and biological defense program
backup books for budget estimates.  In addition, we analyzed chemical
defense-related data for fiscal years 1991 through 1999 contained in
DOD's Future Years Defense Program--the most comprehensive and
continuous source of current and historical defense resource data--to
identify annual appropriation trends and ascertain the level of funds
programmed and obligated for research, development, test, and
evaluation (RDT&E), as well as procurement, and the destruction of
chemical munitions.  We interviewed DOD officials to verify our
observations about low-level efforts and to obtain information about
potential programs currently being developed to expand DOD's efforts
to understand the effects of chronic and low-level exposure of
chemical warfare agents on military personnel.

We contacted the following organizations:

  -- Armed Forces Radiobiological Research Institute, Bethesda,
     Maryland;

  -- Defense Intelligence Agency, Washington, D.C.;

  -- DOD Inspector General, Washington, D.C.;

  -- Department of Energy, Washington, D.C.;

  -- Edgewood Research, Development, and Engineering Center, Aberdeen
     Proving Ground, Maryland;

  -- Israel Institute for Biological Research, Ness-Zonia, Israel;

  -- Joint Program Office, Biological Defense; Falls Church,
     Virginia;

  -- National Ground Intelligence Center, Charlottesville, Virginia;

  -- National Research Council, Washington, D.C.;

  -- Office of the Secretary of Defense, Washington, D.C.;

  -- Oregon Health Sciences University, Portland, Oregon;

  -- University of Texas Health Center at San Antonio, San Antonio,
     Texas;

  -- University of Texas Southwest Medical Center, Dallas, Texas;

  -- Air Force Armstrong Laboratory, Brooks Air Force Base, Texas;

  -- Air Force Research Laboratory, Wright-Patterson Air Force Base,
     Ohio;

  -- Army Chemical School, Fort McClellan, Alabama;

  -- Army Medical Research and Materiel Command, Frederick, Maryland;

  -- Army Medical Research Institute of Chemical Defense, Aberdeen
     Proving Ground, Maryland;

  -- Navy Bureau of Medicine and Surgery, Washington, D.C.; and

  -- Walter Reed Army Institute of Research, Washington, D.C.

We performed our review from September 1997 to May 1998 in accordance
with generally accepted government auditing standards.

CHEMICAL WARFARE AGENTS
========================================================== Appendix II

                        Common name             Symbol
Type of agent           ----------------------  ----------------------
Nerve                   Tabun                   GA

                        Sarin                   GB

                        Soman                   GD

                        Cyclosarin              GF

                        \a                      VX

Vesicant or blister     Mustard                 HD

                        Lewisite                L

Pulmonary toxicants     Phosgene                CG

                        Diphosgene              DP

Incapacitating          \a                      BZ

Vomiting                Adamsite                DM

Cyanides                Hydrogen cyanide        AC

                        Cyanogen chloride       CK

Tear gases              \a                      CN

                        \a                      CS
----------------------------------------------------------------------
\a No common names exist for these agents.

THE NATIONAL DEFENSE AUTHORIZATION
ACT FOR FISCAL YEAR 1994
========================================================= Appendix III

The institutional structure and responsibilities for NBC defense
research, requirements, and doctrine derive from provisions in the
National Defense Authorization Act for Fiscal Year 1994.\1 The act
directed the Secretary of Defense to assign responsibility for
overall coordination and integration of the chemical and biological
program to a single office within the Office of the Secretary of
Defense.  The legislation also directed the Secretary of Defense to
designate the Army as DOD's executive agent to coordinate chemical
and biological RDT&E across the services.

The Joint NBC Defense Board, which is subordinate to the Under
Secretary for Acquisition and Technology, provides oversight and
management of the NBC defense program within DOD.  The NBC Board
approves joint NBC requirements; the joint NBC modernization plan;
the consolidated NBC defense program objective memorandum; the joint
NBC research, development, and acquisition plan; joint training and
doctrine initiatives; and the joint NBC logistics plan.

The Joint Service Integration Group and the Joint Service Materiel
Group serve as subordinates to the NBC Board and execute several of
its functions.  Both groups are staffed with representatives from
each of the services.  The Joint Service Integration Group is
responsible for joint NBC requirements, priorities, training,
doctrine, and the joint modernization plan.  The Joint Service
Materiel Group is responsible for joint research, development, and
acquisition; logistics; technical oversight; and sustainment.

These two groups and the NBC Board are assisted by the Armed Forces
Biomedical Research Evaluation Management Committee, which provides
oversight of chemical and biological medical defense programs.  The
Committee is co-chaired by the Assistant Secretary of Defense for
Heath Affairs and the Director, Defense Research and Engineering.
Figure III.1 illustrates the relationships among the various
organizations responsible for NBC defense.

   Figure III.1:  Joint Service
   NBC Defense Program

   (See figure in printed
   edition.)

--------------------
\1 Title XVII of Public Law 103-160, 50 U.S.C.  1522, as amended.

CHEMICAL WARFARE NERVE AGENT
EXPOSURES AND EFFECTS
========================================================== Appendix IV

Chemical exposure
level                   Effects
----------------------  ----------------------------------------------
Clinical
----------------------------------------------------------------------
Lethal                  Death

Severe                  Loss of consciousness, convulsions, flaccid
                        paralysis (lack of muscle tone and an
                        inability to move), and apnea (transient
                        cessation of respiration)

Moderately severe       Severe dyspnea (difficult or labored
                        respiration), gastrointestinal or
                        neuromuscular signs

Moderate                Miosis, rhinorrhea, moderate to severe
                        dyspnea, reflex nausea, and vomiting

Mild                    Miosis, rhinorrhea, mild dyspnea, reflex
                        nausea, and vomiting

Minimal                 Miosis, with or without rhinorrhea; reflex
                        nausea, and vomiting

Subclinical
----------------------------------------------------------------------
No observable effects   Measurable changes in EEG and brain
                        anticholinesterase activity

8-hour occupational     Exposure would not create any adverse health
limit\a                 effect

72-hour general         Exposure would not create any adverse health
population limit\a      effect
----------------------------------------------------------------------
Note:  The specific dose-response relationship varies with the
specific agent, time of exposure, environmental factors (i.e., wind,
humidity, and temperature), method of exposure (i.e., inhalation,
intravenous, and dermal), activity level of subject, and the presence
of other contaminants.

\a Occupational and general population exposure limits for chemical
warfare agents stored by DOD are determined by the Centers for
Disease Control based on linear extrapolations of experimental
results of experiments involving human volunteers as well as animal
reactions to higher doses.  The National Academy of Science's
Committee on Toxicology is reviewing the scientific validity of
reference doses developed by the Army for the six chemical warfare
agents currently stored by the U.S.  military.  The focus of the work
is to determine whether all the relevant toxicity data have been
appropriately considered.  Particular attention will be paid to the
uncertainty, variability, and quality of data and the appropriateness
of the assumption applied when the current reference doses were
developed.  In addition, the committee will incorporate new research
as appropriate, identify gaps in the research, and recommend
additional research as necessary.

FUNDING TRENDS IN DOD'S CHEMICAL
AND BIOLOGICAL DEFENSE PROGRAM
=========================================================== Appendix V

This appendix provides general information on the funding trends for
DOD's Chemical and Biological Defense Program for fiscal years
1990-97 and 1998-2003.  Funding is shown in four categories:
disposal, which includes the costs associated with the chemical
stockpile disposal program; RDT&E procurement; and operations and
maintenance, including the costs for military personnel.

After the end of the Cold War, DOD funding for chemical and
biological programs increased from about $566 million in fiscal year
1990 to almost $1.5 billion in fiscal year 1997.  These funds include
all military services and the chemical munitions destruction
program.\1 Adjusted for inflation, the total program funding has more
than doubled (see fig.  V.1) over that period and is programmed to
continue growing--peaking in fiscal
year 2002 with a total obligational authority in excess of $2.3
billion (see fig.  V.2).

   Figure V.1:  Chemical and
   Biological Program Funding,
   Fiscal Years 1990-1997

   (See figure in printed
   edition.)

   Figure V.2:  Planned Chemical
   and Biological Program Funding,
   Fiscal Years 1998-2003

   (See figure in printed
   edition.)

--------------------
\1 In 1985, Congress passed Public Law 99-145, the National Defense
Authorization Act of 1986, section 1412 of which directed the Army to
destroy the U.S.  stockpile of obsolete chemical agents and
munitions.  To comply with this direction, the Army established the
chemical stockpile disposal program to incinerate the agents and
munitions on site in specially designed facilities.  The stockpile
consists of rockets, bombs, projectiles, spray tanks, and bulk
containers, that contain nerve and mustard agents.

GLOSSARY
=========================================================== Appendix 0

      ANTICHOLINESTERASE
------------------------------------------------------- Appendix 0:0.1

Agent that inhibits the enzyme acetylcholinesterase.

      APNEA
------------------------------------------------------- Appendix 0:0.2

Transient cessation of respiration.

      CLINICAL
------------------------------------------------------- Appendix 0:0.3

Symptoms as observed by a physician.

      COGNITIVE
------------------------------------------------------- Appendix 0:0.4

Process based on perception, memory, and judgment.

      DOSE-RESPONSE
------------------------------------------------------- Appendix 0:0.5

Effects resulting from a specific unit of exposure.

      DYSPNEA
------------------------------------------------------- Appendix 0:0.6

Difficult or labored respiration.

      EFFLUENT
------------------------------------------------------- Appendix 0:0.7

Waste material discharged into the environment.

      FLACCID PARALYSIS
------------------------------------------------------- Appendix 0:0.8

Lack of muscle tone and an inability to move.

      GY
------------------------------------------------------- Appendix 0:0.9

Gray unit of radiation.

      KG
------------------------------------------------------ Appendix 0:0.10

Kilogram.

      LD50
------------------------------------------------------ Appendix 0:0.11

Median lethal dose.

      MG
------------------------------------------------------ Appendix 0:0.12

Milligram.

      MIOSIS
------------------------------------------------------ Appendix 0:0.13

Constriction of the pupil of the eye.

      NEUROTOXIC
------------------------------------------------------ Appendix 0:0.14

Toxins that exert direct effects on nervous system function.

      ORGANOPHOSPHATE
------------------------------------------------------ Appendix 0:0.15

Family of chemical compounds that inhibit cholinesterase and can be
formulated as pesticides and nerve agents.

      PROPHYLAXIS
------------------------------------------------------ Appendix 0:0.16

Measures designed to preserve health and prevent the spread of
disease.

      RHINORRHEA
------------------------------------------------------ Appendix 0:0.17

Nasal secretions.

      SUBCLINICAL
------------------------------------------------------ Appendix 0:0.18

Manifestations of an exposure that are so slight as to be
unnoticeable or not demonstrable.

      G
------------------------------------------------------ Appendix 0:0.19

Microgram.

      VESICANT
------------------------------------------------------ Appendix 0:0.20

Agent that produces vesicles or blisters.
*** End of document ***